Benign
Positional Vertigo (BPPV)

What is positional vertigo?

Positional vertigo is an inner ear problem. It causes
brief but sometimes severe feelings of spinning. Some people
feel that their head or body is spinning. Others feel the
room is spinning. People often say they are dizzy, but dizzy
is a very general term. Vertigo, on the other hand, is the
very specific feeling of uncontrollable spinning.

Positional vertigo happens suddenly when you change the
position of your head. Another name for this problem is
benign paroxysmal positional vertigo.

How does it occur?

In the inner part of your ear
are 3 semicircular canals. Movement of the fluid in these
canals helps your brain maintain your balance and know what
position you are in (for example, standing up, lying down,
or standing on your head).

Sometimes small crystals of calcium develop and float in
the fluid in the inner ear. This can happen after a head
injury, with a severe cold, or simply as a part of normal
aging. The crystals can cause vertigo when you change head
position and they strike against nerve endings in the
semicircular canals. Usually the calcium crystals dissolve
in a few weeks and stop causing vertigo. However, sometimes
the crystals do not dissolve and the vertigo returns from
time to time.

What are the symptoms?

A sudden feeling that you
are spinning, or that the room is spinning, is the main
symptom. You may feel the vertigo when you first wake up. It
may seem that any turn of your head brings on brief but
intense spells of vertigo. It may happen when you tilt your
head, look up or down, or roll over in bed.

You may have nausea and vomiting along with the vertigo.
Even if a spell of vertigo is brief, you may have a feeling
of queasiness for several minutes or even hours afterward.

How is it diagnosed?

Your health care provider will
ask about your symptoms and examine you. You may also be
given a Dix-Hallpike position test.

You start the Dix-Hallpike test by sitting upright on the
examining table. Your health care provider slowly brings
your head down over the edge of the table and turns your
head to one side. If you have positional vertigo, your
provider will see your eyes making fast, jerky movements
called nystagmus. If no nystagmus is seen, your provider
will repeat the test, this time turning your head to the
opposite side, to test the other inner ear. If you have
nystagmus on this side and you have vertigo, then the ear
that is pointing toward the floor is the one causing the
problem. The nystagmus and vertigo will slow down and stop
after 15 to 20 seconds. If you do not move your head, no
more symptoms will occur. When you sit back up, you will
have vertigo again, but for a shorter time. Other tests you
may have are:

an ear exam

an audiogram to check your hearing

a test of your nerve responses

an electronystagmogram (ENG) test.

How is it treated?

Mild vertigo is often treated with medicine. The most
common medicine for this problem is meclizine. It is taken
up to 4 times a day for the vertigo and nausea or vomiting.
One of the problems with this medicine is that it causes
drowsiness. This is not as much of a problem if you have
severe vertigo, which usually requires bed rest. Then the
medicine can help you sleep and get relief from the vertigo
while you sleep.

Your health care provider may recommend techniques that
use gravity to move the crystals away from the nerve endings
into an area of the inner ear that won't cause any problems.
These are called repositioning techniques.

One repositioning technique is the Epley maneuver. It can
be very helpful. Your health care provider will move your
head into 4 positions. You will hold each position for about
30 seconds.

Your health care provider may also suggest that you do
Brandt-Daroff exercises. Your provider may recommend that
you do these exercises 3 times a day for 2 weeks. To do
these exercises:

Start by sitting upright on your bed.

Lie on your left side, with your head angled upward
about halfway. (Imagine that you are looking at the head of
someone standing about 6 feet in front of you.) Stay in this
position for 30 seconds, or, if you are having vertigo,
until the vertigo stops.

Return to the sitting position for 30 seconds.

Lie on your right side, and follow the same routine.

Your health care provider may refer you to a physical
therapist to learn and practice these repositioning
techniques.

Rarely, when repositioning techniques don't help and the
vertigo has not gone away after a few weeks, severe cases
may eventually require surgery.

How long will the effects last?

Even without
treatment, positional vertigo usually goes away within
several weeks. Sometimes it recurs despite treatment.

How do I take care of myself?

If your vertigo is mild, you may be able to continue
your usual activities, especially if you have
opportunities to sit when you have vertigo.

If your vertigo does not allow you to continue your
usual routine, you should rest at home.

Use medicine as prescribed by your health care
provider to help stop symptoms of dizziness, nausea, and
vomiting.

Follow your instructions for using the repositioning
techniques.

Do not try to drive, operate tools or machinery, or
do other tasks, even cooking, that could endanger
yourself or others if you suddenly become dizzy.